Understanding and Evaluating Nutrition Diagnosis PES Statements

To find the "Real Cause" rather than just a superficial one, use the "5 Whys" technique. When you identify a cause, ask yourself "but why?" up to five times. This drilling process helps you move past symptoms and arrive at a root cause that a dietitian can actually influence.

Example: The "5 Whys" in Action

1. Problem: Undesirable food choices.
2. Why? Because the patient eats in restaurants with limited healthy options.
3. Why? Because they don't like to eat alone.
4. Root Cause: Social isolation/preference for dining with others.

Exam Tip: When writing your etiology, use linking words such as "related to," "associated with," or "as a consequence of" to connect the problem to the cause.

Selecting Measurable Signs and Symptoms

The "S" in PES represents the evidence. For a PES statement to be effective, the signs and symptoms must be specific and measurable. This allows you to evaluate whether your intervention worked during the next follow-up visit.

Avoid vague descriptions. For instance, stating "high intake of energy-dense foods" is less useful than stating "dietary intake of 9000kJ compared to requirements of 7500kJ". The latter provides a clear baseline that can be re-measured to document improvement.

The Five-Question Evaluation Framework

To ensure your PES statement is high quality, run it through these five evaluative questions:

1. Can the dietitian resolve or improve the diagnosis? Can you envision an intervention that addresses the etiology? If you cannot address the etiology directly, your intervention must at least target the signs and symptoms (e.g., if the etiology is decreased taste perception, the intervention might be providing foods with stronger flavors).
2. Does the assessment data support the statement? Ensure your signs and symptoms are backed by the data collected during your assessment.
3. Is the etiology the root cause? Have you asked "Why?" enough times to reach a point where a dietitian can intervene?
4. Will measuring the signs and symptoms tell you if the problem is resolved? If the signs and symptoms change, does that actually mean the nutrition diagnosis has improved?
5. Are the signs and symptoms specific enough to measure? Can you quantify the change at the next visit?

Comparative Analysis: Intake vs. Clinical Domains

The way you frame your PES statement dictates your clinical path. Consider these two examples of the same patient scenario:

• Example A (Intake Domain): Excessive intake of carbohydrates related to limited choices from vending machines as evidenced by 3-6 soft drinks per day and blood sugar levels of 30mmol/L.
• Example B (Clinical Domain): Altered laboratory values related to excessive intake of carbohydrate as evidenced by blood glucose levels of 30mmol/L.

While both are technically accurate, Example A is the superior choice for a dietitian. Why? Because Example A targets the etiology (vending machine choices), which leads directly to a specific nutrition intervention. Example B focuses on the laboratory value, which is a symptom of the problem rather than the driver of the intervention.